Provider Demographics
NPI:1205530128
Name:GARBRECHT, MYRNA MICHELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:MICHELLE
Last Name:GARBRECHT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 AVALON PL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4074
Mailing Address - Country:US
Mailing Address - Phone:405-513-1510
Mailing Address - Fax:
Practice Address - Street 1:4608 AVALON PL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4074
Practice Address - Country:US
Practice Address - Phone:405-513-1510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175871835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX61627OtherTEXAS STATE BOARD OF PHARMACY
OK17587OtherOKLAHOMA STATE BOARD OF PHARMACY